Provider Demographics
NPI:1417406810
Name:LEWIS, LABRINA HELEN (BST)
Entity Type:Individual
Prefix:
First Name:LABRINA
Middle Name:HELEN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6543 GRAND GULCH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1996
Mailing Address - Country:US
Mailing Address - Phone:702-504-0482
Mailing Address - Fax:
Practice Address - Street 1:6543 GRAND GULCH CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-1996
Practice Address - Country:US
Practice Address - Phone:702-504-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner